In the latest installment of our occasional conversations with Fort Worth newsmakers, Dr. Rajesh Gandhi, trauma medical director at JPS Health Network, discusses what it means for the county hospital to be a Level 1 Trauma Center.
This conversation has been edited for length and clarity. For more, please listen to the audio file attached to this article.
Alexis Allison: So Dr. Gandhi, I know that JPS Health Network was recently re-designated as a Level 1 Trauma Center. Can you just tell us what that means?
Dr. Rajesh Gandhi: Sure. Unintentional traumatic injury is the leading cause of death and disability for Americans aged 1 to 44. So this designation by the state tells our community that we have all of the criteria that’s necessary to take outstanding care of our trauma patients.
And JPS provides this service to the residents of Tarrant County and surrounding rural counties as well. Our area is very large: It extends up to Oklahoma. It extends east past Dallas, almost to East Texas. And actually during the last two years, we would get patients from the East Texas area, bypassing Dallas, and also from the west. You know, the Northwest panhandle area, Amarillo, Abilene, all the way to us. And then south, of course, to Waco, even.
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Allison: Well, with this verification process, it’s my understanding that there were more than 300 criteria that the trauma center had to meet to be considered Level 1. Can you tell us about some of those criteria?
Gandhi: Sure. And some of the criteria are general, such as, “Do you have institutional commitment?” And so what does that mean? That means that the board of managers needs to have a resolution that provides support for our center.
It also means that you’re a leader in the regional and state trauma system, and that you accept these patients from your community, which is not just Tarrant County, but the region.
The other big part is to make sure that you have a process improvement and a patient safety system. And what does that mean? That means that you measure your outcomes through risk-adjusted benchmarking. What does that mean? That means that we take a patient that’s gone through our system, and let’s say there was a delay, whether it was a delay to call the trauma surgeon or the trauma surgeon was delayed, or there was a delay in hanging an antibiotic, then we go into, you know, what caused that. And once we know what caused it, then we set a process to improve that. So that the next time, it’s almost impossible for our surgeon to not be there or almost impossible to not have an antibiotic hanging on time or things like that. And so what that means for our community is the highest level of care.
The lowest morbidity and mortality rates are with your Level 1 trauma center. And the reason is that process improvement and patient safety plan that you have for your system. And so we have a very robust plan — and we always try to keep improving that plan.
Allison: It’s interesting, because in my understanding, a Level 1 trauma center can provide for patients who’ve encountered the worst types of trauma. Is that accurate?
Gandhi: Yes. So, in that sense, we’re a one-stop shop. We don’t need to go out to get, you know, a certain kind of specialist. So let’s say a cardiac surgeon, or a thoracic surgeon, or a vascular surgeon, or other specialties, it’s all here. We have hand surgery, we have plastic surgery. So we have all the resources necessary to take care of the most complicated patients and they have the complete continuum of care.
And another huge area for a Level 1 trauma center: very robust in injury prevention, outreach, education, research and scholarship activities. So we had a Stop the Bleed class with Facebook Live. So we teach that course at schools, at different community centers, and it helps the bystander learn how to stop bleeding. And it came out of the Sandy Hook experience. Because it really is a responsibility for everybody. And no matter how good our EMS system is, they will never get to the patient within three minutes, which is the timeframe for somebody to bleed to death. So that’s a huge area of work we do.
Some of the other prevention aspects has to do with looking at your data and saying, “OK, what are your top mechanisms of injury?” And so our top mechanisms of injury are falls, motor vehicle and motorcycle crashes, and then penetrating trauma (like gunshot wounds). And so when we hone down on things that we can work with, then we go into driver impairment prevention, and then for falls, what is that population that has the most fall in for our area? It’s our patients who are 55 years of age and older, that have falls. And so how do we prevent that? So we talk about prevention, and then we talk about our aging population and how to make them stronger.
Allison: You mentioned some of the community training like Stop the Bleed. If a listener were to want to participate in some of those, how would they find out more information about them?
Gandhi: So, if you get onto the JPS website and you go toward trauma, we actually have an online kind of booking, if you will, where you give your name and information. And whether you want us to host a course for you or you want to be in a course, you can sign up and then one of our staff will get back to you. As you can imagine, with the recent shootings, we have had quite a deluge of people interested. So there may be a slight delay in getting back to you, but we will definitely get back to you.
Allison: Thank you for that. And then is there anything else that you’d like listeners to know about trauma care at JPS?
Gandhi: I think most of the community understands that JPS is the place that you want to go to if you’re very sick, and that the outcomes have been exceptional. We take great pride in that. And we do a great deal of work. And I have an outstanding team that I can honestly say is probably the best team that I have worked with in my entire career. Our team is actually the entire institution, because we cannot do anything we do without everybody. So it’s the people in the emergency department in the operating room in the ICU, it’s our environmental services, it’s our linen services. There is not a single area in the hospital that we do not touch.
Allison: Thank you so much for sharing, Dr. Gandhi.
Gandhi: Thank you, Alexis.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email at alexis.allison@fortworthreport.org or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.
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